kepro termination request training guide 20210513
TRANSCRIPT
SMI TERMINATION REQUESTSAtrezzo Submission Guide
Presented by: Brianna WaltonOperations Manager for Kepro Maine
5/13/2021
Hello and Welcome to the Kepro Serious Mental Illness Termination Request training for Section 17 Community Support Services , Section 65 Behavioral Health Services for Adults, Section 92 Behavioral Health Homes, and Section 97 PNMI Services for adults.
The criteria that defines a Serious Mental Illness can be found by view the MaineCare Benefits manual located at www.maine.gov
The guidance presented in this presentation is meant to give providers a basic understanding of the SMI termination process in Atrezzo, and the process once a termination request has been submitted .
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PART ONE
Atrezzo Submission
We will start with a basic overview of submitting a SMI Termination request in Atrezzo.
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Accessing Atrezzo
Visit www.qualitycareforme.com to access the Atrezzo portal
To access the Atrezzo portal, go to our informational website; www.qualitycareforme.com and click on the Atrezzo login button
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Atrezzo Login
Enter in your username and password
Once you click on the Atrezzo login button, you will be brought to the actual login page. Here you will enter in your username and password. If you have forgotten your password, click on the I forgot password link. This will ask you to provide your username and the answer to your security question. Once you have answered your security question, you will be able to reset your own password.
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Creating the RequestOnce you have successful logged in, you will be brought to the home screen of Atrezzo. There are two ways to create a new request. You can click on New Request at the bottom of the home screen, or by click on the requests tab and selecting create new request.
Once you have successfully logged in to Atrezzo, you will be brought to the home screen of Atrezzo. There are two ways to create a new request. You can click on New Request at the bottom of the home screen, or by clicking on the requests tab and selecting create new request.
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Creating the Request
Enter in the member’s MaineCare ID in the Member ID box. If you don’t have the member’s MaineCare ID, you can search for the member by entering in the member’s last name and date of birth
Enter in the member’s MaineCare ID in the Member ID box. If you don’t have the member’s MaineCare ID, you can search for the member by entering in the member’s last name and date of birth and click search.
If the consumer does not have MaineCare, you will be prompted to Create a Temporary member. This should be used for OBH Funded consumers who do not have a MaineCare ID.
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Creating the Request
When you search by the member’s last name and date of birth and no matching records are found, you will be asked to create a temp member. Click on the Temp member button.
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Creating the Request
Complete all member demographic information and click Create Member Record.
On the New Member Information Screen, fill in the member’s demographics and click Create Member Record. Please note, you will not be able to enter any text in the Member ID box. This box will generate a number once you have clicked the create member record.
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Creating the Request
Once you have clicked create member record, a Temporary Member ID will display in the Member ID box. This will act as the member’s ID. To start a request using a temporary member ID, please copy the ID.
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Creating the RequestWith the copied Temporary Member ID, click on Requests and then Create New Requests.
With the copied Temporary Member ID, click on Requests and then Create New Request.
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Creating the Request
Enter in the member’s MaineCare ID in the Member ID box. If you don’t have the member’s MaineCare ID, you can search for the member by entering in the member’s last name and date of birth
In the next screen enter the copied temporary ID in the Member ID and click search.
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Creating the Request
Click on select once the member appears in the member search screen.
Once the member appears in the member search screen, click on select to start the request
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Creating the Request
Click on New Request at the bottom of the Request screen
Click on New Request at the bottom of the Request screen
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Creating the Request
Select Outpatient as the request type
In the select request type box, choose outpatient. The select sub contract will default to Maine ASO. Click Create request to continue.
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Requesting Provider Page
Enter in your agency’s fax number if not already indicated.
Once you have clicked create request, you will be brought to the Requesting Provider page. If your agency’s fax number is not already indicated, please enter in the fax number and click next.
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Service Detail Page
Click on the Service Detail page
Using the tabs on the left-hand side of your screen, click on the Service Detail page. The Service Provider and Attending Physician pages are not required for SMI Termination Requests.
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Service Detail Page
Complete the Service Type and Request Type
In the service type box, enter in the appropriate section of MaineCare policy. In this example we used Section 65. Then enter in your request type as SMI Termination and click next.
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Procedures Page
Enter in the service code that you are requesting to terminate or interrupt
On the procedures page, enter in the service code that you are requesting to terminate or interrupt. Click on find, then enter in the procedure code or description of the code and click find. When the procedure appears, click on select under action. This will add the code to your request. You will notice in this example an asterisk after the service code description. When ever you see this, it means there are more than one procedure code within the description. You will be able to select the appropriate description once the code is added to your request.
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Procedures Page
Enter in the start and end date as the date you are submitting the SMI Termination. Enter one (1) unit in the Qty box.
Once the code has been added, indicate the start and end date as the date the request is being submitted. If the code you add has more than one description, click the drop-down box of the procedure code to get a list of all descriptions of the code. In the quantity box, indicate one (1) unit. Click Next
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Diagnosis Page
Enter in the primary diagnosis code and any subsequent diagnoses.
On the Diagnosis page, enter in the member’s primary diagnosis and any other subsequent diagnosis at time of referral request. Click on find, enter in the diagnosis code or description and click search. When the diagnosis code appears, click select under action to add the code to the request. Repeat the same steps to add each diagnosis code. Click next.
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Clinical Information Page
Clinical information page is not required
NOT REQUIRED
Using the tabs on the left-hand side of your screen, click on the Questionnaire page. The Clinical Information page is not required for Termination Requests
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Questionnaire Page
Complete the Termination Request Questionnaire
Click on the Termination Request Questionnaire and complete the questionnaire.
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Questionnaire Page
Please note, that as you answer the questionnaire some questions will cascade to additional questions if more information is required
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Questionnaire Page
Save changes and return to request
When the questionnaire has been completed, click on the save changes button and then click on Return to Request. It is important that the questionnaire is filled out completely as this is where we will be capturing most of the information about why there is a request to terminate or interrupt services.
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Submitting the Request
Select the pre-certification acknowledgement and click submit.
Once you have returned to the request, scroll to the bottom of the page and check the pre-certification statement and then click submit.
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Submitting the Request
. Once the case has been submitted it will bring you to the request overview page. This will be a receipt of all information provided in the request. It is important to document the Case ID to reference this request at a later time.
Please note: You will also be able to search and find the consumer by other identifying information like Name, DOB, etc.
Once the case has been submitted it will bring you to the request overview page. This will be a receipt of all information provided in the request. It is important to document the Case ID to reference this request at a later time
Please note: You will also be able to search and find the consumer by other identifying information like Name, DOB, etc.
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PART TWO
Post Submission
Now that we have reviewed the process for submitting a SMI Termination request, we will review what happens post submission
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Daily Authorization Report
Once your request has been submitted, Kepro’s Clinical team will review the request within 48 business hours. In some instances, Kepro will contact the member or guardian to discuss the request and in other instances, the request may be sent to OBH for review. Once the request is reviewed and if determined to be an appropriate termination, Kepro will document the outcome in your termination case and will submit a formal discharge on behalf of the provider. Please note that for Adult PNMI services, OBH will be reviewing all termination requests submitted through Atrezzo.
The Daily Authorization Report is the primary way Kepro communicates to providers regarding the status of a case. In the Atrezzo portal, users who have been setup as a Group Admin + Reports or Admin +Reports User will have a Reports tab. Within the reports tab, you will find the Daily Authorization Report which will give you updates as cases change status.
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Questions?
Toll-Free Phone: (866) 521-0027
Option 1 – Member Services Option 2 – Katie BeckettOption 3 – Provider RelationsOption 4 – Care ManagementOption 5 – Appeals
Email: [email protected]
www.qualitycareforme.com
Thank you for joining the Kepro Termination Request Training. If you have further questions or need assistance, please call us at 866-521-0027. For technical assistance, please press Option 3 to reach a member of our Provider Relations Team. You can also reach a member of our Provider Relations Team via email at [email protected] Our hours of operation are Monday thru Friday 8am to 6pm.
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